Dyspnea

Retno Ariza

Definition

Abnormally uncomfortable awarness of breathing

Intensity quantified Sensation

Normal breathing : respiratory rate about 14 20/mnt (adult), up to 44 (infant) Bradypnea : slow breathing (causes as coma,drug induced respiratory depression) Tachypnea : rapid shallow breathing (restrictive lung disease)

Abnormally of rhythm of breathing

Cheyne-Stokes breathing : periods of deep breathing alternate with periode apnea (brain damage) Kussmaul breathing : rapid deep breathing has causes metabolic acidosis Biots breathing : ataxic breathing is characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods (respiratory depression and brain damage)

American Thoracic Society Shortness of Breath Scale

0 (none) no troubled by shortness of breath when hurrying on the level or walking up a slight hill 1(mild) troubled by shortness of breath when hurrying on the level or walking up a slight hill 2(moderate)walk slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level

American Thoracic Society Shortness of Breath

3(severe) stop for breath after walking about 100 yard or after a few minutes on the level 4(very severe) too breathless to leave the house or breathless on dressing or undressiing

Cause

Chest wall Pleura Neuromuscular Lung disease Heart disease Metabolic system

Renal Hematology Rheumatohologic Psychiatric disorder Endocrine changes (pregnancy)

History taking of dyspnea

Acute (Asthma, MCI, pneumonia, CHF), chronic (respiratory distress from muscular dystrophy) Nocturnal dypnea : Asthma, CHF,gastroesophageal reflux,nasal congestion Supine position : pregnancy, acites,diaphragmatic paralysis Symptoms are intermittent (reversible disease) : asthma, CHF,COPD Symptoms appear with somethink induced (smoke,allergen) : asthma

Lung disease

Airway obstruction
Extrathoracic airways to lung periphery Upper airway obstructrion inspiratory stridor & retraction of supraclavicular fossae Intrathoracic obstruction asthma

Diffuse parenchymal lung disease Pulmonary embolism

Heart disease
pulmonary capillary pressure Fatigue of respiratory muscles Exertional breathlessness orthopnea paroxymal nocturnal dyspnea

Others

Disease of the chest wall or respiratory muscles

Severe kyphoscoliosis Spinal deformity Bilateral diaphragmatic paralysis

Other objective testing in the evaluation of dyspnea

After complete history & physical examination determine of the system

Respiratory system Cardiovascular system Metabolic disturbance, musculosceletal ect

Choice the objective testing

Respiratory infection : hematology (leucocyte,diff count), Blood gas analysis, x ray

Resiratory obstruction :Pulmonary Function Test (spirometry) Malignancy in respiratory system : broncoscopy, CT Scan CVS : EKG,ECHO Metabolic : Blood sugar, BGA, renal function test,ect

Peak flow meter

Spirometry

Bronchoscopy

Radiology

Radiology

Pleura Space

To use M D I

Nebulizer